Doctor of Philosophy / Human Nutrition / Richard R. Rosenkranz / Child stunting refers to a condition where the child is relatively shorter in height, in comparison to their age group. Child stunting is a public health nutrition problem that hinders the development of future generations, not only physiologically but also potentially deprives their cognitive function and productivity. The demographic transition, conjoined with the epidemiological and nutrition transitions, has resulted in the coexistence of an over- and under-nutrition problem known as double burden of malnutrition, and child stunting has been a persistent part of the problem. In 2014, the World Health Organization (WHO) reported that one-fourth of the children in the developing countries have been suffering from child stunting. The objective of this research was to apply the behavioral epidemiology approach to tackle child stunting in households with double burden of malnutrition. It was hypothesized that unlike any other households with problem of child stunting, households with double burden of malnutrition possess some degree of capacity that, with proper support and direction, might enable them to help themselves reduce or prevent this nutrition-related debacle. Results from a secondary data analysis revealed that child stunting was associated with lower dietary diversity as an indication of poor food choice in the household, related to children’s nutrient requirements. Another cross-sectional study in this dissertation was conducted in an urban setting in Indonesia, and found that households with child stunting alone was associated with extreme food insecurity, while households with double burden of malnutrition ─ in the form of stunted child and overweight/obese mother (SCOWT) ─ was associated with even a mild degree of food insecurity. These results support our hypothesis that households with double burden of malnutrition lack the capacity to direct their resources properly to prevent child stunting. Most notably, we expected that the role of the mothers to manage healthy food choices through indirect measure of dietary diversity, availability and distribution within the household was lacking. In order to equip mothers with necessary components to be able to overcome these problems, we conducted a behaviorally based intervention that targeted mothers in the households experiencing the problem of double burden of malnutrition. The intervention provided the potential to achieve participant self-administered goal setting to improve diet, as well as child feeding behavior, by means of improved self-efficacy, nutrition literacy and dietary diversity. Maternal self-efficacy may be potentially enhanced by vicarious experience and active mastery experience gained during 6 sessions of behavioral intervention and verbal motivation by community health workers during 6 additional home visits. These studies, collectively comprising the present dissertation, present a message for policy makers in developing countries: nutrition literacy and behaviors for choosing healthy foods are lacking in mothers that affect both maternal and child food intake, but efforts such as improving vicarious and mastery experience on child feeding practices and healthy food choices can boost mother’s self-efficacy to engage in appropriate behaviors and improve their child’s nutrition.

Questa tesi è composta di tre saggi collegati relativi a povertà, distribuzione del reddito e stato di nutrizione dei bambini in Uganda. Il primo saggio intitolato “Poverty reduction and Income Distribution Impacts of Exogenous Policy Shocks in Uganda: A Social Accounting Matrix Perspective” analizza come e quali settori ed agenti economici sarebbero maggiormente colpiti da shock esogeni di politica economica che abbiano l'obiettivo della crescita economica, distribuzione del reddito e della riduzione della povertà. La metodologia applicata in questo studio è un modello di equilibrio economico generale - il modello del moltiplicatore della Matrice di Contabilità Sociale (SAM)- basato sulla SAM Ugandese del 2002. Il secondo saggio intitolato “Measurement of Multidimensional Child Poverty in Uganda” utilizza indicatori antropometrici ed un indicatore composito della ricchezza famigliare come misure del benessere dei bambini e applica l'approccio del Dual Cutoff e Counting proposto da Alkire e Foster (2007, 2011) per costruire un indice multidimensionale della povertà infantile in Uganda. Il terzo saggio, intitolato “The Relationship Between Maternal Autonomy and Child Stunting in Uganda” utilizza utilizza misure di autonomia femminile quali la libertà di movimento per visitare la famiglia ed i parenti, il potere decisionale nel fare cospicue spese familiari e giornaliere e l'atteggiamento femminile verso l'abuso fisico e verbale per analizzare la relazione tra autonomia femminile e rachitismo infantile in Uganda. I dati per i saggi 2 e 3 provengono dall'Uganda Demographic and Health Survey (UDHS) per l'anno 2006. I risultati dimostrano che il settore immobiliare, agricolo, commerciale e di trasformazione alimentare sono fondamentali in Uganda; 30% dei bambini sono multidimensionalmente poveri e una bassa autonomia materna è associata al rachitismo. / The thesis consists of three interrelated essays on poverty, income distribution and child nutritional status in Uganda. The first essay titled “Poverty reduction and Income Distribution Impacts of Exogenous Policy Shocks in Uganda: A Social Accounting Matrix Perspective” asks, how and which sectors and economic agents would be most affected by exogenous policy shocks that target growth, income distribution and poverty reduction? This is answered by a way of a general equilibrium model - the social accounting matrix (SAM)-based multiplier model based on the 2002 Uganda SAM. The second essay titled “Measurement of Multidimensional Child Poverty in Uganda” uses the anthropometric indicators and a household composite wealth indicator as measures of child well-being and applies the Dual Cutoff and Counting approach proposed by Alkire and Foster (2007, 2011) to construct a multidimensional child poverty index for Uganda. The third essay titled “The Relationship Between Maternal Autonomy and Child Stunting in Uganda” uses direct evidence on measures of women’s autonomy namely, freedom of movement to visit families or relatives, decisionmaking power on making large household and daily purchases, and women’s attitude toward verbal and physical abuse to examine the relationship between maternal autonomy and child stunting in Uganda. Data for essay 2 and 3 were drawn from the Uganda Demographic and Health Survey (UDHS) for the year 2006. Results show that key sectors in Uganda are Real estate, Agriculture, Trade and Food processing industries; 30% of children are multidimensionally poor; and low maternal autonomy is associated with stunting.